NURS 6521 Week 4 Assignment - Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Running Head: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Introduction In this case study I will be discussing pharmacotherapy for gastrointestinal (GI) and hepatobiliary disorders. The patient that is presented in a case study is HL that came in to the clinic due to nausea, vomiting and diarrhea which are related to possibility of GI infections and hepatobiliary disease Per patients history, it is evident patient has a history of drug use and possible hepatitis C. Patient appears to be taking Synthroid 100mcg daily, Nifedipine 30mg daily and Prednisone 10mg daily. I will be discussing the diagnosis and a proper drug therapy plan for this patient. Rationale for Diagnosis of the Patient With patients current symptoms presented, it is difficult to diagnose the patient right away. Hepatobiliary and gastrointestinal disorders can be very complicated to diagnose. It can be a potential diagnosis of simple food poisoning to stomach cancer with similar symptoms. It is important for me to as a practitioner to ask the patient additional questions in order to get a proper diagnosis. I would ask the patients questions that are pertaining to his medical history and current medication regimen in order to get a thorough assessment. These are the questions I would ask: • How long have you been using drugs in the past and if currently is using any drugs? • How long have you had hepatitis C for? • Why are you taking Prednisone? 3 Running Head: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders • Are there any other medical history that I should be aware of due to your treatment with Synthroid and nifedipine? • How long have you been experiencing current symptoms? • Do you struggle with constipation and how often you go to the bathroom? • Have you travelled anywhere recently? It will be important for me as practitioner to find out why is patient taking prednisone and for how long. Corticosteroids are frequently used in patients with autoimmune hepatitis and liver diseases, which showed great improvements in quality of life and extended longevity of patients (National Institute of Diabetes and Digestive and Kidney Diseases, 2014). Corticosteroids can be beneficial in controlling inflammation in patient with many different diseases and disorder. But, there can be many adverse side effects from taking corticosteroids such as; gastrointestinal bleeding, immunosuppression and peptic ulcers (Rosenthal & Burchum, 2021) With presented symptoms of the patient and current medication regiment it is possible that patient could have gastroenteritis. Patient could have contracted Helicobacter pylori (H.pylori) organism. It is evident that H.pylori and gastroenteritis is very common in USA and affects about 30-40 % of the population yearly (Chang et al., 2017). H.pylori is spread easily by direct contact of stool, vomit, contaminated food/water or saliva and can cause peptic ulcers and gastritis ( Chang et al., 2017) Patient is taking prednisone medications with no knowledge of how long the medication has been taken, which could have caused immunosuppression and possibility of contracting H.pylori. 4 Running Head: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Drug Therapy Plan and Recommendations When creating a treatment plan and prescribing medications, it is important to consider drug interactions. For the treatment of H.pylori it is recommended to use a combination of at least two antibiotics, proton pump inhibitors (PPI) or histamine 2 blockers and bismuth subsalicylate to coat the stomach (Rosenthal & Burchum, 2021). Per studies, it is evident that Clarithromycin and amoxicillin are most effective antibiotics for H. Pylori. Since the patient is on nifedipine and prednisone it is contraindicated to take clarithromycin, since it will increase nifedipine level in the body and cause shock or heart block and rupture of the tendons from prednisone combination (Rosenthal & Burchum, 2021). Also, I would be careful with prescribing PPI. Rosenthal and Burchum (2021) stated that PPI can decrease the absorption of Synthroid, therefore it will need monitoring of the thyroid-stimulating-hormone level or switch to a histamine 2 blockers as a replacement. Treatment that will be effective and safe for this patient would be (Khoshnood et al., 2019) • 1st Antibiotic: Azithromycin 250mg, once a day for 10 days • 2nd Antibiotic: Amoxicillin 1000mg twice daily for 10 days • Proton Pump Inhibitor: Omeprazole 20mg twice daily for 10 days • Bismuth Subsalicylate: Pepto Bismol 525mg twice daily for 10 days • Antiemetic: Zofran three times a day as needed for nausea • Increase hydration due to diarrhea and loss of fluids • Offer antidiarrheal over the counter medications